美国计算机断层扫描筛查与肺癌分期和生存的关联：类实验研究

SCI

22 April 2022

Association of computed tomography screening with lung cancer stage shift and survival in the United States: quasi-experimental study

（BMJ；IF:39.89）

• Potter AL, Rosenstein AL, Kiang MV, et al. Association of computed tomography screening with lung cancer stage shift and survival in the United States: quasi-experimental study. BMJ. 2022

• CORRESPONDENCE TO : cjyang@mgh.harvard.edu

Objective 目的

To determine the effect of the introduction of low dose computed tomography screening in 2013 on lung cancer stage shift, survival, and disparities in the stage of lung cancer diagnosed in the United States.

明确美国于2013年引入的低剂量计算机断层扫描筛查对肺癌分期转换、生存和分期差异的影响。

Design 设计

Quasi-experimental study using Joinpoint modeling, multivariable ordinal logistic regression, and multivariable Cox proportional hazards modeling.

应用Joinpoint建模、多变量序数逻辑回归和多变量Cox比例风险模型的类实验研究。

Setting 背景环境

US National Cancer Database and Surveillance Epidemiology End Results program database.

美国国家癌症数据库和SEER数据库。

Participants 参与者

Patients aged 45-80 years diagnosed as having non-small cell lung cancer (NSCLC) between 1 January 2010 and 31 December 2018.

2010年1月1日至2018年12月31日期间被诊断患有非小细胞肺癌 (NSCLC) 的45-80岁患者。

Main outcome measures 主要结局及测量方法

Annual per cent change in percentage of stage I NSCLC diagnosed among patients aged 45-54 (ineligible for screening) and 55-80 (potentially eligible for screening), median all cause survival, and incidence of NSCLC; multivariable adjusted odds ratios for year-to-year changes in likelihood of having earlier stages of disease at diagnosis and multivariable adjusted hazard ratios for changes in hazard of death before versus after introduction of screening.

45-54 岁（不适合筛查）和 55-80 岁（可能适合筛查）的患者中诊断出的 I 期 NSCLC 百分比、中位全因生存和 NSCLC 发病率的年度百分比变化；多变量调整比值比，用于诊断时患有早期疾病的可能性的逐年变化，以及在引入筛查之前与之后死亡风险变化的多变量调整风险比。

Results 结果

The percentage of stage I NSCLC diagnosed among patients aged 55-80 did not significantly increase from 2010 to 2013 (from 27.8% to 29.4%) and then increased at 3.9% (95% confidence interval 3.0% to 4.8%) per year from 2014 to 2018 (from 30.2% to 35.5%). In multivariable adjusted analysis, the increase in the odds per year of a patient having one lung cancer stage lower at diagnosis during the time period from 2014 to 2018 was 6.2% (multivariable adjusted odds ratio 1.062, 95% confidence interval 1.048 to 1.077; P<0.001) higher than the increase in the odds per year from 2010 to 2013. Similarly, the median all cause survival of patients aged 55-80 did not significantly increase from 2010 to 2013 (from 15.8 to 18.1 months), and then increased at 11.9% (8.9% to 15.0%) per year from 2014 to 2018 (from 19.7 to 28.2 months). In multivariable adjusted analysis, the hazard of death decreased significantly faster after 2014 compared with before 2014 (P<0.001). By 2018, stage I NSCLC was the predominant diagnosis among non-Hispanic white people and people living in the highest income or best educated regions. Non-white people and those living in lower income or less educated regions remained more likely to have stage IV disease at diagnosis. Increases in the detection of early stage disease in the US from 2014 to 2018 led to an estimated 10 100 averted deaths.

从 2010 年到 2013 年，55-80 岁患者中诊断出的 I 期 NSCLC 的百分比没有显著增加（从 27.8% 到 29.4%），然后从 2014 年开始以每年 3.9%（95% 置信区间 3.0% 到 4.8%）的速度增加，直至 2018 年（从 30.2% 到 35.5%）。在多变量调整分析中，2014 年至 2018 年期间，诊断时肺癌分期较低的患者每年的比值增加 6.2%（多变量调整比值比 1.062，95% 置信区间 1.048 至 1.077；P <0.001) ，高于从 2010 年到 2013 年每年增加的几率。同样，55-80 岁患者的中位全因生存从 2010 年到 2013 年（从 15.8 个月到 18.1 个月）未见显著增加，随后从 2014 年到 2018 年（从 19.7 到 28.2 个月），每年增加 11.9%（8.9% 到 15.0%）。在多变量调整分析中，与 2014 年之前相比，2014 年之后死亡风险的下降速度明显更快（P<0.001）。至 2018 年，I 期非小细胞肺癌是非西班牙裔白人和生活在收入最高或受教育程度最高地区的人的主要诊断。非白人和生活在收入较低或受教育程度较低地区的人在诊断时仍然更有可能患有 IV 期疾病。从 2014 年到 2018 年，美国早期疾病检测的增加避免了估计 10100 人死亡。

Conclusions 结论

A recent stage shift toward stage I NSCLC coincides with improved survival and the introduction of lung cancer screening. Non-white patients and those living in areas of greater deprivation had lower rates of stage I disease identified, highlighting the need for efforts to increase access to screening in the US.

最近向 I 期 NSCLC 的分期转变与生存率的提高和肺癌筛查的引入相吻合。非白人患者和生活在更贫困地区的患者的 I 期疾病发病率较低，这突出表明需要努力增加在美国获得筛查的机会。

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